The competing interests shaping health promotion in New Zealand Building Community Capacity or Eroding Professional Capacity? Sarah Lovell

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Presentation on theme: "The competing interests shaping health promotion in New Zealand Building Community Capacity or Eroding Professional Capacity? Sarah Lovell"— Presentation transcript:

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The competing interests shaping health promotion in New Zealand Building Community Capacity or Eroding Professional Capacity? Sarah Lovell sarah.lovell@otago.ac.nz Ph: +64 3 479 8087 Department of Preventive & Social Medicine University of Otago

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The foundations of Health Promotion The Ottawa Charter for Health Promotion, signed in 1986, identified the role of health promotion being to: Build healthy public policy Strengthen community actions Create supportive environments Develop personal skills Reorient health service The politics of health promotion: Self care vs. fostering healthy environments

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Community Capacity Building Conceptual connections to social capital Community capacity building strategies help to sustain health promotion programmes beyond their funded life (Hawe, 1998) Community capacity building is central to the work of health promoters in new Zealand Community capacity building seeks to enhance the resources, skills, and networks of communities to promote health and wellbeing (Labonte and Laverack, 2001).

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The changing health agenda The 1990s saw a growing contract culture in New Zealands health system The prescriptive contracting environment of the 1990s has been replaced, in many policy areas, by the rhetoric of partnership (Matheson, Howden-Chapman and Dew, 2005). Establishment of DHBs and PHOs cemented the importance of community participation into New Zealands health system

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Research Rational What challenges do funders and planners of health promotion face in supporting community capacity building? Reign of biomedicine Community capacity building carried out covertly in Australia (Hawe, 1998) Absence of research on health promotion workforce in New Zealand History of health system restructuring PHOs another facet of health system change Political vulnerability

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Methods Study built on earlier research Interviews conducted with twenty-one planners and funders of health promotion recruited from five regions: Represented were NGOs (4), PHOs (5), DHBs (3) and public health units (3) and National NGOs (6) The full range of PHU/DHB relationships was captured Heavy participation of individuals prominent in health promotion sector Interviews, lasting between 18 min and 1hr20min, were audio- recorded and later transcribed NVivo used to facilitate data analysis

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Eroding Community Trust Turnover of health promotion staff hinders community capacity Limited-term contracts undermine community relationships Competition for contracts can strangle opportunities for collaboration with other organisations …it's really important to make sure that staff are happy and stay in their jobs… having worked in the community myself before, I know it takes at least three years to develop those sorts of relationships so if you have a high turnover you just don't get anything done and then people lose trust in your organisation, if you like, or that position in terms of having a good relationship so it is important to try and have stable staff…. (N1_NGO)

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Health Promotion Workforce Limited training and workforce development opportunities for regional NGOs Fundraising a drain on time for NGO health promoters Pay equity between organisations [There are] major inequalities of salaries and then the NGO health promoters go to the DHB to get more money so it's like robbing or poaching staff… we have no way of dealing with that through scholarships or secondments and those sorts of things have been talked about over the years, heaps over the years, capacity within the NGO, perception of what health promotion is - that's a barrier - you know, and a lack of not just capacity for health promoters in NGOs but just generally lack of capacity. (PC1:DHB)

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In health in New Zealand with the health reforms that came in when it was made available that non-governmental organisations could actually contract for some of the health funding… and so a lot of NGOs, Maori, Iwi trusts got contracts and werent well supported with how they implemented them so theres some history there with some quite bad stories with funding not being utilised properly, funding being provided and we now have stories of immunisation costing $1000 each and that sort of stuff doesnt help when it comes to trying to advocate for money to go to these NGOs and local groups. Thats one barrier, I think that because they were set up to fail is part of the issue and then everyone says well they havent done it properly so why would we give them more money?' And that sort of thing and its really hard to turn around. (PC1:DHB)

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Changing Relationships Conflicting views on effectiveness of health promotion within PHOs has heightened divisions Emergence of 80 PHOs diluted potency of PHO funding Shifting provider landscape has threatened many health promotion contracts Vulnerability of NGOs in times of political change I think health promotion in New Zealand is a mess and I don't think it quite knows what it is and, in general, some sectors are getting on with it and doing a reasonable job like the PHO sector is dong a good job. They've had to. They've got health promotion money, they've attracted a whole lot of people from places and on the whole I think they're doing a really good job at evidence-based health promotion. (N3)

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Building the Capacity of Which Community? I was talking about last year kind of the ultimate community development is when you're not acknowledged. When you're not measured, you know, the outcome isn't your flag-waving. The ultimate community development is when you achieve what you achieve and you slip out the side door when everyone is patting themselves on the back about what a great job they've done and you don't get any recognition at all. And that, that to me, that mode and concept of working doesn't fit too flashly with the model and concept of being in the health sector, you know the medical model, where you've been through for fifteen years to be top of your field and good on you but… you slog your guts out and generally you want some personal acknowledgement of that. (PB1:PHO:1) Poor understanding of community development in health sector Poor public understanding of health promotion Ground-level work dominates community capacity building/health promotion in New Zealand Health promotion currently politically vulnerable

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Significance Is health promotion a sector in crisis? The damage of restructuring Undermines community relationships and erodes the capacity of organisations Insecurity within sector Bio-medical approaches continue to dominate budgets

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Conclusions Health promotion has been strangled by a lack of leadership Innovations are taking place outside of the sector Failure of PHOs and public health units to coordinate their services; who should take the strategic role? A change in government means a change in health strategy: will health promotion go back in time?

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Thanks To the BRCSS network for funding this postdoctoral research and to Robin Kearns who has been my mentor for the project.